Provider Demographics
NPI:1760619266
Name:ROBERTS, JUSTIN PATRICK
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:PATRICK
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1628
Mailing Address - Country:US
Mailing Address - Phone:814-536-5611
Mailing Address - Fax:
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1628
Practice Address - Country:US
Practice Address - Phone:814-536-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health